Non-communicable diseases in low- and middle-income countries: context, determinants and health policy.
The rise of non-communicable diseases and their impact in low- and middle-income countries has gained increased attention in recent years. However, the explanation for this rise is mostly an extrapolation from the history of high-income countries whose experience differed from the development processes affecting today's low- and middle-income countries. This review appraises these differences in context to gain a better understanding of the epidemic of non-communicable diseases in low- and middle-income countries. Theories of developmental and degenerative determinants of non-communicable diseases are discussed to provide strong evidence for a causally informed approach to prevention. Health policies for non-communicable diseases are considered in terms of interventions to reduce population risk and individual susceptibility and the research needs for low- and middle-income countries are discussed. Finally, the need for health system reform to strengthen primary care is highlighted as a major policy to reduce the toll of this rising epidemic.
Miranda
J J
JJ
Non-communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Kinra
S
S
Casas
J P
JP
Davey Smith
G
G
Ebrahim
S
S
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D002908:Chronic Disease / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006291:Health Policy; D019456:Health Transition; D006801:Humans; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000517:prevention & control; D009369:Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D018673:Nutrition Policy; D009765:Obesity / Q000150:complications; D011785:Quality Assurance, Health Care / Q000592:standards*; D012307:Risk Factors